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Offer an escape route from suffering, not from life

27 March 2008

Offer an escape route from suffering, not from life

Agnes Kant, SP member of Parliament and spokeswoman on health care issues

"Halsema would permit assisted suicide to old people who are tired of life". When I read this headline above an interview with the leader of the Green Left (1) in De Volkskrant (2), I was put in mind of the many reactions which we have received to our TV ad drawing attention to the dehumanisation of health care (3). In addition to the recognition which this ad received, I had also regularly to contend with furious reactions such as "I wouldn't put up with that any more" and "if I have to grow so old, I'd rather just be given a pill." Femke Halsema continued her pleas on Wednesday in a parliamentary debate on euthanasia. She wants to see, she says, "old people who are finished with life' able to ask for help in committing suicide, and has therefore asked the government to look into the possibility of broadening the current law on euthanasia.(4)

The SP supports existing practice on euthanasia in the Netherlands. It is good that people who are without any prospect of recovery and who are suffering unbearable pain can choose a dignified death. This was already the case before the law was introduced, and in practice the law actually changed nothing for either patient or doctor. The difficult consideration of whether to end a life is the task of the patient, together with the doctor and people close to the patient, to be performed in mutual trust.

A broadening of the possibilities which might lead to euthanasia, as Halsema proposes, is in my view socially undesirable and even dangerous. The idea cannot be separated from the manner in which old people, the people who built this country, are now being treated.

The desire to die cannot be separated from the question of the quality of life. And quality of life is partly determined by the conditions and circumstances of life. That is why Halsema's words made me think of those reactions to the TV ad. The conditions are unfortunately often far from dignified. Witness the sadly persistent, appalling examples of inadequate care and privacy in nursing homes. And what should we think about the problems now afflicting home-based care? I am receiving a growing volume of evidence indicating that even in the case of terminally ill patients such care is either not available or inadequate. Loneliness and hopelessness are also major problems amongst old people. A cultural, social and political problem indeed, and one which we as a society must address. Old people's quality of life is, after all, to a large extent determined by the way in which the government provides the services which are needed in old age.

Self-determination cannot be separated from the question of a person's general circumstances and their social surroundings. Of course everyone should have the freedom to determine whether they wish to die. But to what extent will this desire be a purely autonomous choice and to what extent will this possibility, in large part - or wholly - unconsciously, be attributable to a feeling of redundancy, or to loneliness.

Of course, I can certainly understand that there are some old people who have had enough, who are "finished with life" and who in complete freedom have decided that they wish to determine for themselves the moment of their death, But it is not to be wished that this should become a normal option. Such a new "freedom" could easily turn into a new "unfreedom".

"Human dignity should always take precedence over self-determination." So concluded Jan Marijnissen in his 2001 article on euthanasia in the progressive religious and cultural periodical Roodkoper.
We must do all that we can to offer people who are suffering a way out of that suffering, rather than a way out of life.

(1) The Green Left (Groen Links) is a parliamentary party with 7 seats in the Netherlands' main legislative chamber.
(2) A leading daily newspaper.
(3) In this ad an extremely old lady says that as she can no longer have the care assistant whom she has known for many years to help her undress - as this care assistant had proved to be "too expensive" – and instead must have a series of strangers, she "might as well undress in front of the whole of the Netherlands" - which she then proceeds to do.
(4) Under the existing law, introduced in 2001, the patient's decision must be "voluntary, well considered and persistent, in the presence of unbearable pain without hope of improvement. The decision should be made by more than one doctor, and the doctor and patient should agree that euthanasia is the only reasonable option." (Brian Pollard, Catholic Education Resource Centre)